Venous thromboembolisms are the leading cause of preventable hospital death, underscoring the need for clinical leaders to build a strong prevention program.
During a March 24 webinar hosted by Becker's Hospital Review and sponsored by Cardinal Health, Tania Hoyer, MSN, RN, critical care clinical educator at Doylestown (Pa.) Hospital, shared evidence that highlights opportunities for improvement, as well as strategies to foster a best-in-class VTE prevention program.
Bill Nadeau, Global Director of Medical Affairs at Cardinal Health, moderated the discussion.
Five key takeaways:
1. Non-adherence to VTE prophylaxis is a significant problem. "Patient refusal occurs in about 8.5 percent to 18.2 percent of pharmacologic VTE prophylaxis," Ms. Hoyer said. Additionally, a 2017 study focused on mechanical prophylaxis found improperly placed or no mechanical devices on 81 percent of trauma patients.
2. A VTE prevention committee should be multidisciplinary. This should involve leadership and executive champions, pharmacy staff, providers, front-line nursing staff, patient education and a patient advocacy group. After forming the committee, start with a gap analysis to guide focus areas for the group, Ms. Hoyer said. Starting off with a comprehensive analysis into protocols and adherence helps give a clear picture of your hospital's current state with VTE prevention and how to move forward.
3. Build protocol into the workflow. For example, adding the reason for patient refusal of VTE prophylaxis and provider notification into nursing documentation can encourage nurses to follow up with patients and inform them of different options. Multidisciplinary rounding is also an effective way to boost adherence when embedded in the workflow. "During multidisciplinary rounding, you [nurses] can have a conversation with your intensivist or hospitalist to say, 'Are you sure you really want to do this? The patient is uncomfortable with getting an injection, can we find something else?'" Ms. Hoyer said. "Then, you get buy-in from all members of the team."
4. Utilize digital resources to boost patient education. Educational videos focused on VTE prophylaxis are a simple way to inform patients of the risks of blood clots. In some cases, such videos can be pulled from larger agencies like the CDC, eliminating the task of filming your own content. If a patient declines treatment for VTE prevention, try sending patients another video with a bit more information. "Then, they're hearing it from multiple different sources, not just the nurses taking care of them," Ms. Hoyer explained. "They're [patients] actually seeing something from a large agency." Send these via a notification that shows up on the television in patients' rooms if possible, Ms. Hoyer added.
5. Offer continuing education credits to incentivize clinical staff when possible. Given the dynamic and demanding nature of nursing work, clinical education can be difficult to implement. Nurses have very little down time, Ms. Hoyer explained, adding that digital options are an effective way to increase nurses' understanding of VTE prophylaxis, especially when a continuing education credit is offered.
To watch the full webinar, click here.